Combined hysteroscopic Bigatti shaver (IBS®) and resectoscope removal of a heterotopic cesarean scar pregnancy in the first trimester

Wei Liu; Yang Yue; Xiaoman Hou; Huayu Han; Wei Wang; Xiaoyan Lin

doi:10.1016/j.fertnstert.2024.04.024

Combined hysteroscopic Bigatti shaver (IBS®) and resectoscope removal of a heterotopic cesarean scar pregnancy in the first trimester

Fertil Steril. 2024 Apr 24:S0015-0282(24)00258-9. doi: 10.1016/j.fertnstert.2024.04.024. Online ahead of print.

Authors

Wei Liu¹, Yang Yue², Xiaoman Hou², Huayu Han², Wei Wang³, Xiaoyan Lin⁴

Affiliations

¹ Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China. Electronic address: 2583546770@qq.com.
² Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
³ Department of Ultrasound Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
⁴ Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.

PMID: 38670328
DOI: 10.1016/j.fertnstert.2024.04.024

Abstract

Objective: To report a case of heterotopic cesarean scar pregnancy reduction by combined hysteroscopic Bigatti shaver (IBS®) and resectoscope with the preservation of a normal gestational sac in the uterine cavity under simultaneous transabdominal ultrasound guidance.

Design: Video article STATEMENT OF CONSENT: The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites.

Setting: University-affiliated hospital PATIENT(S): A 30-year-old woman, G5P2A2L2, with 2 previous cesarean deliveries and a history of fertility problems was admitted with a heterotopic cesarean scar pregnancy at 7⁺² gestational weeks. Ultrasound examination showed a dichorionic diamniotic pregnancy. The first gestational sac (1.7×1.7×0.6 cm) was located in the previous hysterotomy scars with a thin layer of myometrium measuring 0.2 cm in thickness and a rich blood supply. The second chorionic sac (2.8×2.4×1.8 cm) was observed at the uterine fundus. Normal cardiac activity and yolk sacs were observed in both gestational sacs. The couple strongly desired to preserve the intrauterine pregnancy.

Intervention(s): After Institutional Review Board (IRB) approval was obtained, a hysteroscopic integrated Bigatti shaver combined with a bipolar resectoscope was used to remove the heterotopic cesarean scar pregnancy while preserving the intrauterine gestational sac under simultaneous transabdominal ultrasound guidance.

Main outcome measure(s): The heterotopic cesarean scar pregnancy was completely resected by hysteroscopy, and the gestational sac in the uterine cavity was successfully preserved.

Result(s): Trophoblastic tissue was confirmed by histopathological examination. The patient had an unremarkable postoperative recovery. Subsequent serial ultrasonography confirmed a single ongoing pregnancy with normal growth parameters and a normal placental site.

Conclusion(s): The inability of a Bigatti Shaver to perform coagulation can be offset by combination with the bipolar resectoscope. Hysteroscopic Bigatti shaver combined with resectoscope to remove a heterotopic cesarean scar pregnancy offers a short operation time and minimum blood loss. It could be an optimized approach for the management of heterotopic cesarean scar pregnancy in the first trimester when an intrauterine pregnancy needs to be preserved.

Keywords: Bigatti shaver; fetal reduction; heterotopic cesarean scar pregnancy; hysteroscopy; intrauterine pregnancy conservation.